Skip to main content

Research Repository

Advanced Search

Cognitive behaviour therapy to prevent harmful compliance with command hallucinations (COMMAND): a randomised controlled trial

Birchwood, Max; Michail, Maria; Meaden, Alan; Tarrier, Nicholas; Lewis, Shôn; Wykes, Til; Davies, Linda; Dunn, Graham; Peters, Emmanuelle

Authors

Max Birchwood

Maria Michail

Alan Meaden

Nicholas Tarrier

Shôn Lewis

Til Wykes

Linda Davies

Graham Dunn

Emmanuelle Peters



Abstract

Background Acting on command hallucinations in psychosis can have serious consequences for the individual and for other people and is a major cause of clinical and public concern. No evidence-based treatments are available to reduce this risk behaviour. We therefore tested our new cognitive therapy to challenge the perceived power of voices to inflict harm on the voice hearer if commands are not followed, thereby reducing the hearer’s motivation to comply.
Methods In COMMAND, a single-blind, randomised controlled trial, eligible participants from three centres in the UK who had command hallucinations for at least 6 months leading to major episodes of harm to themselves or other people were assigned in a 1: 1 ratio to cognitive therapy for command hallucinations + treatment as usual versus just treatment as usual for 9 months. Only the raters were masked to treatment assignment. The primary outcome was harmful compliance. Analysis was by intention to treat. The trial is registered, number ISRCTN62304114.
Findings 98 (50%) of 197 participants were assigned to cognitive therapy for command hallucinations + treatment as usual and 99 (50%) to treatment as usual. At 18 months, 39 (46%) of 85 participants in the treatment as usual group fully complied with the voices compared with 22 (28%) of 79 in the cognitive therapy for command hallucinations + treatment as usual group (odds ratio 0·45, 95% CI 0·23–0·88, p=0·021). At 9 months the treatment effect was not significant (0·74, 0·40–1·39, p=0·353). However, the treatment by follow-up interaction was not significant and the treatment effect common to both follow-up points was 0·57 (0·33–0·98, p=0·042).
Interpretation This is the first trial to show a clinically meaningful reduction in risk behaviour associated with commanding voices. We will next determine if change in power was the mediator of change. Further more complex trials are needed to identify the most influential components of the treatment in reducing power and compliance.

Journal Article Type Article
Publication Date Jun 20, 2014
Journal The Lancet Psychiatry
Print ISSN 2215-0366
Electronic ISSN 2215-0374
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 1
Issue 1
APA6 Citation Birchwood, M., Michail, M., Meaden, A., Tarrier, N., Lewis, S., Wykes, T., …Peters, E. (2014). Cognitive behaviour therapy to prevent harmful compliance with command hallucinations (COMMAND): a randomised controlled trial. Lancet Psychiatry, 1(1), doi:10.1016/S2215-0366(14)70247-0
DOI https://doi.org/10.1016/S2215-0366%2814%2970247-0
Publisher URL http://www.sciencedirect.com/science/article/pii/S2215036614702470
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf

Files

PIIS2215-0366(14)70247-0.pdf (189 Kb)
PDF

Copyright Statement
Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf





You might also like



Downloadable Citations

;